Non-Specialist Management of Tropical Talipes

Abstract

Talipes equinovarus (clubfoot) is a complex deformity which in the West is usually treated by trained orthopaedic surgeons. In developing countries, however, most clubfeet will need to be treated by medical officers lacking specialist training. We report one author's experience in treating clubfeet in a small, rural East African hospital and review the literature in order to assist other non-specialists in managing this difficult condition in the face of poverty and poor parental compliance.

Assessing Knowledge on Clubfoot Among Parents Having Children with Clubfoot Deformity

“…Many individuals with untreated clubfoot end up living as beggars on the streets 10 . It has been shown that only 10% of children with clubfoot in East Africa are able to access treatment from a specialist owing to inadequate awareness, poor communication, travel expenses and increased parental responsibilities of care in the family 11 . Currently, only 2% out of over one million people with disabilities in Uganda receive rehabilitation services 12 .…”

Perceptions Regarding Medical Management of Clubfoot in Kenya

“…This can only be achieved by bringing the parents/caregivers on board through counselling and education (Huber et al, 2012;Ding et al, 2012). A study by Scott and Evans (1997) on clubfoot management in Tanzania found that most 77 of the children with clubfoot that were treated using the Ponseti management were lost to followup before achieving satisfactory results. This indicated that compliance to treatment that involves consecutive attendances can be challenging.…”

“…The institutions that exist for clubfoot management are more often located in urban areas and are therefore inaccessible to people living in rural areas due to poor communication, travel expenses and inadequate awareness (Scott & Evans, 1997).…”

“…Poor adherence to casting and bracing among parents/caregivers of children with clubfoot is a major dilemma experienced by service providers in delivery of health care services (McEvoy, (Scott & Evans, 1997). They reported that of the 26 patients that participated in the study on clubfoot, only a minority of parents/caregivers of children with clubfoot attended the clinic for more than three sessions for treatment.…”

“…They reported that of the 26 patients that participated in the study on clubfoot, only a minority of parents/caregivers of children with clubfoot attended the clinic for more than three sessions for treatment. In their study, none of the participants attended the clinic satisfactorily to either be discharged after complete recovery or for surgery to be deliberated after inadequate management with non surgical intervention (Scott & Evans, 1997).…”